This question is mainly for Derek Miles. I’d like your opinion on something. I’m in my first year of PT school, and I’m struggling a bit to come to terms with the sheer magnitude of pseudo-scientific quackery being presented to me in my curriculum. Does it get better when you’re out practicing on your own? Do you feel like you can still command respect as a clinician within the medical community at large based on your own merits? I want to be proud of my job and what I do and not feel embarrassed to call myself a physical therapist one day. It’s actually made me consider quitting and going to med school. How much of my experience is a problem with my school versus being a representation of ignorance at the level of APTA and accredidation standards?
I know you’re looking for Derek’s feedback here, but I noticed no one responded. Maybe I can give you some feedback and others will chime in.
I think this has the potential to be a nice learning platform if you’re willing to discuss things a bit more in depth. If it helps, I’m proud of what I do every day. I agree, many of things being taught in school are outdated and sometimes rubbish. Conversely, there is a lot of very good information too. I don’t think that’s reason for jumping ship. You are likely in a doctorate program. This is the ideal environment to ask questions, challenge ideas, beliefs and have in depth conversations. And if that’s not happening, I assure you it can/will here…
You obviously seem a bit distraught with what you’re learning. Do you have more specific examples of what you’re learning and being taught? Would you be willing to discuss further?
@Archidel My apologies for the delay in response. I will agree with what Matt said in that there is a lot of good information being taught in school to go with what has less utility. One topic that is increasingly being discussed is how do we change the current paradigm and my typical response is it starts with current DPT students beginning to realize there is a problem. The issue is I think too many of us get in to practice and forget about how bad some parts of what school taught were. I know you are frustrated but I would challenge you to take this as a sort of meta learning experience where you use what is being taught as a heuristic for developing what you think is “right” and “wrong” with practice. A big part of the transition to PT being a doctoral profession was predicated upon us being able to reason through why we believe what we believe and use that to provide best care for our patients.
I originally wanted to be a physician but honestly was deterred from pursuing that as a career mostly because if I had to go to school with the cohort of my biochem class at Clemson for another four years I think my head would have exploded. I say this as a “if you think medicine is doing any better on the pseudo-science side of things you’re mistaken.” PT is our “in group” so we are typically more aware of the problems on our own doorstep. Medicine is exposed to the same antiquated reasoning and treatments that we are, there just tends to be a hierarchal respect given to them from the “lower groups.” That respect is often unfounded and that is why I’m happy to associate with Austin and Jordan whom I have the utmost respect for.
With anything, it ultimately comes down to the people you associate your self with. If you are starting out on this forum as a student you are in the right place. My job affords me the ability to make a difference in people’s lives in a positive way, I would not trade that for anything. You have chosen a good field to get in to and are already reaching out to surround yourself with good people. The APTA definitely has fault, and many of us are somewhat disenfranchised with it, but change only comes from challenging the status quo and it is starting to happen. My best advice to you as a student is reach out to the clinicians you respect. Go and attend conferences and meet those clinicians. You’ll see there is a lot of good out there and a lot of smart people within the profession that really do want to help.
Derek
I’m in my third & final year of DPT and can say with confidence that it’s not just your school. The whole point of PT school is to get us to pass NPTE/boards, so that the school can have a higher pass rate, so that they can keep getting students. Especially as the profession seems to be expanding and class sizes are growing. Especially if it’s a private school - gotta get that sweet sweet money.
To your larger point (and I’m not sure if you’ve run into this issue yet), it’s not just the school/faculty you have to please. Whenever you go out on clinicals/rotations/internships, your CI (or multiple CIs) will be grading you & your performance on something called the CPI (clinical performance instrument), which essentially determines if you pass the rotation or not. And if you don’t pass the rotation, you get held back a year. Which, y’know, completely screws you over, especially if you’re married or have a family to support.
Now depending on your CI, this experience could be completely fine, or it could also be a huge headache. I’ve had a few dinosaurs/old-school PTs who are set in their ways. I’ve tried introducing higher-intensity resistance training (“why would you do that?”), experimented with Pain Neuroscience Education (dismissed as “trendy, a fad”). I question the value of all these special tests we learn, I question the role that biomechanics has on pain, I try to place more emphasis on lowering threat levels, ruling out any serious pathology requiring a referral, and focus on the rehab/training process itself, as opposed to “identifying the tissue source of pain” (because we can’t). By doing this, you will get a lot of push-back from CIs, and you as a student can be pressured into becoming a mini-me of the CI, for better or worse. I’m currently out on my last rotation at an outpatient ortho setting, and it’s a daily struggle with one of my CIs.
As a student you need to graduate, first and foremost. Without a license, we have no legs to stand on. After that, we can become our own clinicians with our own license and our own way of doing things. Hopefully the students who are currently in or entering the field can change the profession by being leaders, ala Derek and Michael.
But it’s hard to change the institution when we’re students, because there’s a different power dynamic and other people’s licenses at stake. And if you have a family to support, you need to graduate ASAP to get licensed and get a job. Question as much as you can, keep an open mind, and SNIP often (smile, nod, ignore, proceed).
So I want to comment here as this is something I hear all the time and it bears expanding upon. Part of the reason things don’t change is because after students graduate they forget how shitty their experience was. The biggest advice I can give in this regard is make it a goal to become a clinical instructor and change the paradigm. We all had awful CIs who did not want to be challenged and were stuck in their ways but if you really want to make a difference, be different than those assholes. The only way the power dynamic changes is if there is pushback and unfortunately many graduate and never associate with their school again. Once you are an alumni the school is likely going to come asking for money. When they do, offer (constructive) feedback on why you are not going to donate. I am ridiculously proud of most of the instructors I had in physical therapy school and was fortunate enough to be there when a lot of profession shifting research was going on. I also had to sit in on a lecture where some dumbass said pink tape was warming and blue tape was cooling. Every CSM I still get together with those instructors and we talk about where we are and what is good and bad, over time the exercise prescription class has improved dramatically but it still falls short of where I would expect it to be. That being said, I do recognize there is a broad scope of things students need exposed to during school and sometimes what I would consider ideal comes at the expense of what a neuro therapist would consider necessary.
But above all else, do not turn in to that asshole CI with multiple letters after their name and a closed mind. If you do a good job as a CI you’re pointing students in the right direction and that is how things ultimately change.
You sound a lot like I was as a 2nd and 3rd year student. Here is some feedback:
-
Listen to what Derek said. You will be a CI someday. Ensure it is a positive experience for your student. You will be shaping their career and enthusiasm for the profession. Challenge them (I do
) but keep their drive to learn more and ask questions intact. With that said, you will be impacting thousands of their future patients. Your reach is enormous if you become a clinical instructor someday. -
While experienced PTs may be set in their ways, they still have a lot you can learn from. How do they interact with the patient? How do they build therapeutic alliance? Find something positive you can take away. Continue asking questions. It will help you and your CI.
-
Don’t get too confident and certain in what you’ve learned or been told. Here is a thought: maybe your patient doesn’t want high intensity work. Maybe PNE isn’t as effective as those promoting it say it is (see JAMA; Traeger et. al 2018). Maybe the patient simply enjoys the social component of interacting with an adult healthcare worker. Maybe the outcome was determined before they ever entered the clinic. Seek alternative hypothesis to what you are thinking and remain uncertain.
Just chiming in for support: you’re not alone. just entered my third trimester of my DPT program, and some of my classmates and I are often questioning the things we are taught as fact. As mentioned above, PT school has the main goal of producing students who are capable of passing the board exams (not to mention CAPTE dictating curriculum). But one thing I often think about is: all of the solid rehab professionals out there like Derek Miles, Michael Ray etc. all went through the same experience of learning a bunch of silly BS to get their respective licenses, and look how they turned out!
Something not enough PT’s talk about openly: “Is PT school a good investment?”
Great feedback, thank you!
Also, relevant Clinical Athlete podcast just popped up - youtube.com/watch?v=ZwHK1ck0qXs
Thanks for the responses everyone.
I have definitely become less panicked and more grounded by networking with more like minded clinicians and students. I’ve realized like Derek said that there really are a whole lot of good doctors embodying the best of what the physical therapy profession can be too. Those people give me an ideal to strive for and allow me to keep my previously voiced concerns in perspective.
As I go into my next semester I’ll try to use the mixed bag of good and questionable information I learn every day as an opportunity to refine my critical thinking skills.
I like the idea of becoming a CI one day and helping future PTs too. What frustrates me the most is seeing some of my classmates blindly accept everything we are being taught, knowing full well that some of them do not possess the critical thinking skills to ever question things and they will never evolve their beliefs beyond what they were just told.
Matthew, since you asked for some specifics about what I’m being taught: I was told the valsalva was evil and will cause strokes on Day 1. Every class I have is geared towards identifying structural pathology through special tests like range of motion with a goniometer, posture assessment, etc. We have a teacher for manual therapy who is the embodiment of every structuralist doctor stereotype who spouts so much nonsense about “snapping adhesions,” unlevel hips, “stiff fibular heads,” etc. that I can’t keep track. We are taught that manual therapy causes physiological changes to tissue, that stretching occurs by plastic deformity instead of as a result of central nervous system tolerance, etc. I have teachers who have no problem with acupuncture or dry needling. It’s a lot to swallow having been exposed to pain science…Also none of my teachers lift whatsoever, but I already wasn’t expecting that lol.
… yikes.